- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,822.00 / $26,147.20 / $34,138.80
| Facility | | $3,822.00 | $26,147.20 | $34,138.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,569.32 / $63,939.86
| Facility | | $5,840.42 | $23,569.32 | $63,939.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,774.02 / $24,429.16 / $36,912.75
| Facility | | $14,774.02 | $24,429.16 | $36,912.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,691.92 / $34,691.92 / $34,691.92
| Facility | | $34,691.92 | $34,691.92 | $34,691.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,286.47 / $24,610.18 / $38,003.89
| Facility | | $21,286.47 | $24,610.18 | $38,003.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $23,569.32 / $63,939.86
| Facility | | $5,840.42 | $23,569.32 | $63,939.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,840.42 / $18,569.50 / $49,969.57
| Facility | | $5,840.42 | $18,569.50 | $49,969.57 |